Provider Demographics
NPI:1699086629
Name:KY DOCTORS OF OPTOMETRY, PLLC
Entity type:Organization
Organization Name:KY DOCTORS OF OPTOMETRY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBESH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:726-444-4078
Mailing Address - Street 1:PO BOX 846027
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6027
Mailing Address - Country:US
Mailing Address - Phone:210-524-6663
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:500 WINCHESTER AVE
Practice Address - Street 2:STE. 810
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7362
Practice Address - Country:US
Practice Address - Phone:606-324-3672
Practice Address - Fax:606-324-4566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1240070030Medicare NSC